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Infectious Dirorder
 

Infectious Dirorder

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    Infectious Dirorder Infectious Dirorder Presentation Transcript

    • Pulmonary T.B Pneumonia Lung Abscess Influenza Presenter: Shahina Amiry Sr. Instructor AKUSON
      • Definition:
      • TB is a bacterial infection caused by Mycobacterium tuberculosis. It most commonly affects the lungs, producing pulmonary TB.
      • Cause:
      • Gram +ve Mycobacterium
      • tuberculebacilli.
      06/07/09 www.health-nurses-doctors.com
    • Pathophysiology
      • Susceptible person inhaled the organism
      • The organism settles in the alveoli and multiply
      • The organism may also transport through blood stream and lymph system to other parts of the body
      • The body immune system respond by initiating inflammatory process and phagocytes take place
      • The tissue reaction causes accumulation of the exudates into the alveoli and causes bronchopneumonia
      06/07/09 www.health-nurses-doctors.com
      • Granulomas are formed which transformed into the fibrous tissues
      • The bacteria and macrophages become necrotic and form the cheesy mass
      • Compromised and inadequate immune response, re-infection and activation of dormant bacteria develop active disease
      • Ghon tubercle ulcerate and cheesy material releases into bronchi and bacteria become airborne and cause active tuberculosis
      • Scar tissue form
      06/07/09 www.health-nurses-doctors.com
    • 06/07/09 www.health-nurses-doctors.com
    • Risk factors & Transmission
      • Airborne droplet during coughing, sneezing, spitting, talking, laughing, singing.
      • History of TB, personally, or amongst friends or family.
      • Migration from a country with a high incidence of TB.
      • History of travel to an area with a high incidence of TB.
      • Alcohol and/or drug abuse.
      • Compromised immunity due to illness, e.g., HIV infection.
      • Malnutrition
      • Over crowd
      06/07/09 www.health-nurses-doctors.com
    • 06/07/09 www.health-nurses-doctors.com
    • SIGN AND SYMPTOM 06/07/09 www.health-nurses-doctors.com
    • Diagnostic test
      • Tuberculin skin test QuantiFERON-TB Gold test
      06/07/09 www.health-nurses-doctors.com
    • Treatment: 06/07/09
      • Medications:
      • Primary Agents Secondary Agents
      • isoniazid* capreomycin
      • ethambutol cycloserine
      • pyrazinamide (PZA) ethionamide
      • rifampin kanamycin
      • Streptomycin para-aminosalicyclic acid (PSA)
      • *most frequently used
      06/07/09 www.health-nurses-doctors.com
    • Side Effects of Medication 06/07/09 www.health-nurses-doctors.com
    • NURSING PRIORITIES
      • 1. Achieve/maintain adequate ventilation/oxygenation.
      • 2. Prevent spread of infection.
      • 3. Support behaviors/tasks to maintain health.
      • 4. Promote effective coping strategies.
      • 5. Provide information about disease process/prognosis and
      • treatment needs.
      06/07/09 www.health-nurses-doctors.com
      • Diagnosis:
      • Infection, risk for spread/reactivation
      • Airway Clearance, ineffective
      • Nutrition: imbalanced, less than body requirment
      • Knowledge, deficient regarding condition, treatment, prevention, self-care, and discharge needs
      06/07/09 www.health-nurses-doctors.com
      • Infection, risk for spread/reactivation
      • Instruct patient to cough/sneeze and expectorate into tissue and to refrain from spitting.
      • Proper disposal of tissue and good hand washing techniques.
      • Identify individual risk factors for reactivation of tuberculosis
      • Awareness of transmission possibilities help patient take steps to prevent infection of others.
      • Note: AFB can pass through standard masks; therefore, particulate respirators are required.
      06/07/09 www.health-nurses-doctors.com
      • Assess respiratory function, e.g., breath sounds, rate, rhythm, and depth, and use of accessory muscles.
      • Note ability to expectorate mucus/cough effectively, document character, amount of sputum, presence of hemoptysis.
      • Place patient in semi- or high-Fowler’s position.
      • Assist patient with coughing and deep-breathing exercises.
      • Clear secretions from mouth and trachea; suction as necessary.
      • Maintain fluid intake of at least 2500 mL/day unless contraindicated
      • Provide oral care before and after respiratory treatments.
      06/07/09 www.health-nurses-doctors.com
    • Nutrition: imbalanced, less than body requirements
      • Document patient’s nutritional status on admission
      • Encourage selection/ingestion of well-balanced meals.
      • Ascertain patient’s usual dietary pattern, likes/dislikes.
      • Encourage small, frequent meals with foods high in protein and carbohydrates.
      • Monitor I&O and weight periodically.
      • Investigate anorexia and nausea/vomiting, and note
      • possible correlation to medications.
      • Monitor frequency, volume, consistency of stools.
      06/07/09 www.health-nurses-doctors.com
      • Compliance with multidrug regimens for prolonged periods is difficult, so directly observed therapy (DOT) should be considered.
      • Aids in monitoring the effects of medications and patient’s response to therapy.
      • Monitor laboratory studies, e.g., sputum smear results; Liver function studies, e. g., AST/ALT.
      06/07/09 www.health-nurses-doctors.com
    • Discharge Teaching 06/07/09
    • 06/07/09 Summarization www.health-nurses-doctors.com
    • 06/07/09 www.health-nurses-doctors.com
    • PNEUMONIA
      • Pneumonia is an Inflammation of alveoli and lungs parenchyma associated with a marked increase in interstitial and alveolar fluid.
      06/07/09 www.health-nurses-doctors.com
    • Causes and Risk factor
      • Bacterial (s.aureus, streptococcus, hemophilus influenza, pseudomonas)
      • Viral
      • Fungi
      • head injury or general anesthesia
      • Exposure to chemicals
      • Tracheal intubation
      • Immuno-suppression(AIDS)
      • Aspiration of food, fluids or vomitus.
      06/07/09 www.health-nurses-doctors.com
      • Bedridden, paralyzed, or unconscious
      • Chronic diseases (diabetes & heart failure)
      • Chronic obstructive pulmonary disease.
      • Very young and very old
      06/07/09 www.health-nurses-doctors.com
    • Pathophysiology organism Susceptible host pneumonia Organism via blood 06/07/09 www.health-nurses-doctors.com
    • Pathophysiology
      • Inhalation of pathogen and harmless bacteria enter into the lower reparatory tract
      • Inflammatory reaction occurs in the alveoli and produces an exudates that interfere with diffusion of oxygen and carbon dioxide.
      • The WBCs especially neutrophills migrate to alveoli and fill the air containing space
      • The area of the lungs are not adequately ventilated because of secretion and mucosal edema
      • Hypoventilation
      • Arterial hypoxemia
      06/07/09 www.health-nurses-doctors.com
    • 06/07/09 www.health-nurses-doctors.com
    • Sign and symptoms
      • * Productive cough Fever & chills
      • Dyspnea Sweating
      06/07/09 www.health-nurses-doctors.com
    • Less common sign & symptoms
      • Fatigue
      • Rapid breathing and heart beat
      • hemoptysis
      • Chest pain
      • Nausea, vomiting, and muscle aches
      • Loss of appetite
      06/07/09 www.health-nurses-doctors.com
    • Pneumonia by Location in the Lung
      • Lobar Pneumonia
      • Bilateral Pneumonia
      • Segmental Pneumonia
      • Bronchopneumonia
      • Interstitial Pneumonia
      • Alveolar Pneumonia
      • Necrotizing Pneumonia
      06/07/09 www.health-nurses-doctors.com
    • Pneumonia by Origin of Infection
      • Community-Acquired Pneumonia (CAP):
      • Most common causes of bacterial CAP is Streptococcus pneumonia
      • Hospital-Acquired Pneumonia. Staphylococcus aureus
      • Aspiration Pneumonia
      06/07/09 www.health-nurses-doctors.com
    • Diagnostic evaluation
      • Medical history Physical examination
      • Chest X-ray CBC /ABGs
      • Culture of Sputum.
      06/07/09 www.health-nurses-doctors.com
    • Treatment
      • Medical management
      • Hospitalization Antibiotic therapy
      • Nebulization
      06/07/09 www.health-nurses-doctors.com
    • Nursing Process
      • Assessment:
      • History
      • Physical examination
      06/07/09 www.health-nurses-doctors.com
    • Nursing Diagnosis
      • Ineffective airway clearance related to copious tracheobronchial secretions.
      • Impaired Gas Exchange related to altered oxygen-carrying capacity of blood
      • Activity intolerance relate to Imbalance between oxygen supply and demand.
      • Altered nutrition less than body requirement
      06/07/09 www.health-nurses-doctors.com
      • Respiratory Isolation
      • Promote airway patency
      • Maintain hydration
      • Perform chest protocol
            • Deep breathing exercise
            • Chest Physiotherapy
            • Use of spirometer
            • Suction
            • Postural drainage
      06/07/09 www.health-nurses-doctors.com
      • Maintain accurate intake and output.
      • Administer antipyretics and antibiotics on timely manner.
      • Encourage the low energy utilization activities.
      • Observe color of skin, mucous membranes, and nail beds, noting presence of peripheral cyanosis
      06/07/09 www.health-nurses-doctors.com
    • Instruct Parents on Discharge
        • About medication administration
        • Increase fluids intake
        • Humidified air
        • Signs and symptoms of respiratory distress
        • Postural drainage techniques
        • Follow care Complications
      06/07/09 www.health-nurses-doctors.com
    • 06/07/09 www.health-nurses-doctors.com
    • Definition
      • Lung abscess is Collection of pus within lungs.
      06/07/09 www.health-nurses-doctors.com
    • CAUSES
      • Bacteria
      • Fungi
      • Commonest cause is aspiration
      • Unconscious or very drowsy because of sedation, anesthesia, alcohol or drug abuse, or a disease of the nervous system (CVA).
      06/07/09 www.health-nurses-doctors.com
    • Pathophysiology
      • Lung infection (infectious agent) causes collection of pus
      • Pus form cavity that is formed by the necrosis of the lung tissues
      • Fibrosis tissue form around the abscess to wall it off
      • Erosion of abscess in the bronchial system causes fouls smell sputum
      06/07/09 www.health-nurses-doctors.com
    • Sign And symptoms
      • Chills
      • Fever
      • Foul smell cough
      • Shivering
      • Night sweat
      • Purulent sputum
      06/07/09 www.health-nurses-doctors.com
    • Diagnostic Evaluation
      • Medical history
      • Blood test
      • Chest x-ray
      • CT as needed
      • Sputum cultures
      • Bronchoscopy as needed to exclude cancer
      06/07/09 www.health-nurses-doctors.com
    • Management
      • Antibiotics (penicillin, cephalosporin)
      • Oxygen may be given to patients who are having trouble breathing.
      • Drainage or aspiration of abscess through bronchoscopy.
      • Pulmonary resection (lobectomy) very rare
      06/07/09 www.health-nurses-doctors.com
    • Nursing Management
      • Emphasize on compliance
      • Teach coughing exercise
      • Chest physiotherapy
      • Frequent mouth care
      • Provide adequate rest, good nutrition and increase fluid intake
      • High protein high caloric diet.
      06/07/09 www.health-nurses-doctors.com
    • INFLUENZA
      • Definition :
      06/07/09 www.health-nurses-doctors.com
    • Prevalence / Epidemiology
      • 2003 Large outbreak of influenza A(H5NI) or avian flu spread among poultry in Asia.
      • By 2004 humans had infected in nine countries.
      • Influenza differs from common cold primarily in its sudden onset and widespread occurrence in population.
      06/07/09 www.health-nurses-doctors.com
    • Types
      • Influenza A ;
      • Responsible for regular outbreaks, including the one of 1918. Influenza A viruses also infect domestic animals (pigs, horses, chickens, ducks) and some wild birds
      • Influenza B: causes localized out, especially in residential communities like nursing homes.
      • Influenza C :common but cause fewer symptoms
      06/07/09 www.health-nurses-doctors.com
    • Causes / Risk Factors
      • Spreads from person to person through respiratory droplets from coughing and sneezing
      • Occasionally from touching something with virus on it and then touching mouth or nose
      06/07/09 www.health-nurses-doctors.com
      • Adults may be able to infect others 1 day before getting symptoms and up to 7 days after getting sick
      • Immunocompromised
      • Resident of chronic care facility and health care worker
      06/07/09 www.health-nurses-doctors.com
    • Signs and Symptoms 06/07/09 www.health-nurses-doctors.com
    • Diagnostic Evaluation
      • CBC, CXR
      • Throat swab for culture
      06/07/09 www.health-nurses-doctors.com
    • Management
      • Interventions are based on manifestation as they arise.
      • Vaccination (70-90 effective) must be given in mid October
      • Antiviral drugs
      • Antibiotics
      • Anti-pyretic
      06/07/09 www.health-nurses-doctors.com
    • Nursing Management
      • Highly contagious disease*
      • Respiratory isolation
      • Promote Rest
      • Adequate Hydration
      • Promote airway patency (chest Protocol)
      • Assess for high risk from complications of the flu such as people 65 years or older, people with chronic medical conditions, pregnant women and young children.
      06/07/09 www.health-nurses-doctors.com
    • 06/07/09 www.health-nurses-doctors.com
    • 06/07/09 www.health-nurses-doctors.com